Major pharmaceutical companies Novo Nordisk A/S and Eli Lilly & Co. are highlighting upcoming pill versions of their successful weight-loss drugs, expected to hit the market as early as next year. However, hopes for more affordable options with fewer side effects may be dashed, raising concerns for both patients and insurers.

The blockbuster injections, such as Lilly’s Zepbound and Novo’s Wegovy, have been lucrative for the companies, prompting the exploration of oral alternatives. Pfizer Inc. and AstraZeneca Plc are also eyeing the weight-loss market, projected to reach $100 billion in the next seven years.

While oral medications are generally easier to produce, store, and transport, the cost and side-effect issues persist. Novo’s Rybelsus, a pill version of their diabetes shot commonly used for weight loss, is currently priced at $936 for a one-month supply, mirroring the cost of the injections.

The high-dose version of Rybelsus, specifically designed for weight loss, is under consideration for European approval. In trials, patients taking it daily on an empty stomach experienced a remarkable 15% reduction in body weight in just over 16 months. However, the pill comes with limitations, including a waiting period before eating and an increased risk of gastrointestinal side effects compared to the injections.

Lilly’s experimental pill, orforglipron, offers a potential advantage with “no restrictions in terms of food and water intake,” according to Lilly executive vice president Patrik Jonsson. In trials, the daily pill demonstrated substantial weight loss, comparable to the highest experimental dose of Rybelsus, though nausea and vomiting remained common.

Market analysts suggest that Lilly’s pill may have a competitive edge over Novo’s, with the potential to enter the market in the coming years. Pfizer, aiming for a resurgence in revenue after pandemic-related sales decline, is also focusing on an obesity pill currently in mid-stage study.

However, concerns about side effects have prompted Pfizer to split its drug into two daily doses during trials. Despite reassurances from Pfizer, ongoing data collection and review are crucial, especially regarding potential liver enzyme elevation.

Several biotechs, including Viking Therapeutics Inc. and Structure Therapeutics Inc., are also in the race to develop effective obesity pills. Structure’s mid-stage human trials have shown promising results, outpacing Pfizer’s efforts, according to analysts.

Looking ahead, AstraZeneca’s recent licensing of a pill from China’s Eccogene, anticipated to be more affordable, indicates the evolving landscape of weight-loss medications. AstraZeneca’s Pascal Soriot believes that a cheaper product with broader accessibility could be a game-changer.

Experts predict a wave of new weight-loss drugs in the next five to ten years, marking the beginning of a transformative era in the field. As pharmaceutical giants compete to offer effective and accessible solutions, the evolution of obesity medications is far from reaching its conclusion.